Many women struggle with the disorder for weeks or months, but there are effective treatments. Self-prescribed therapies risk being counterproductive, specialist opinion is needed
They wander between general practitioner, gynecologist, pharmacist, sometimes even a urologist, even passing through the emergency room because of the pain. A cure follows (mostly with antibiotics) and the indication to drink (“a lot of water, which is good”) and then they do the urine culture again to check the situation. If the problem persists: repeat the therapy. Thus it happens that many women struggle with cystitis for weeks, sometimes months, without being able to solve the problem permanently. Not infrequently opting for the “do it yourself”, which does not bring results or even risks making the situation worse. Yet there are effective treatments for this disorder that affects almost one in two women throughout their lives, starting from adolescence, the first sexual intercourse and until after menopause.
The risk of antibiotic resistance
Statistics indicate that up to 40% of Italian women (ie 10 million compatriots in all) are affected at least once in their lives by urinary infections and about 20% of them report having had episodes that have recurred over time. In four out of five cases it is cystitis, an inflammation of the bladder almost always caused by bacteria present in the intestinal flora which, for various reasons, can cause damage to the urinary tract. “The solution does not lie, as too often thought, in self-prescribed antibiotic treatments because they risk being counterproductive, increasing the probability of developing antibiotic resistance – he underlines Andrea Salonia, Head of the Educational Office of the Italian Society of Urology (SIU) —. It is necessary contact the expert in the sector, i.e. the urologistwhich can indicate the most suitable therapeutic path for cystitis, which often also includes small interventions in the lifestyle ».
What symptoms shouldn’t be overlooked?
«The alarm bells with which cystitis presents are usually always the same: an urgent and often painful urge to urinate, a burning sensation when urinating, a feeling that you will never be able to completely empty your bladder he replies Andrea Salonia, professor of Urology at the Vita-Salute San Raffaele University in Milan —. Urine may appear cloudy and foul-smelling, sometimes with traces of blood. Above all, there is a sense of heaviness and discomfort in the lower part of the abdomen».
What are the effective therapies?
«The strategies to solve the problem go first of all from an intervention on lifestyles – explains the expert -. A golden rule in case of episodic cystitiswhich however also applies as a form of prevention, is that of drink a lot: at least 8 glasses of water a day, to purify the body and avoid the accumulation of toxins and bacteria responsible for inflammation. For the same reasons it is very important to try not to hold back, but immediately indulge the urge to urinate, because the stagnation of urine in the bladder facilitates the proliferation of bacteria. It is then recommended to urinate before and after sexual intercourseuse pH neutral and non-aggressive intimate cleansers. To control constipation, a potential promoter and ally of cystitis, it may be useful to eat a couple of kiwis a day: regulate the intestine and are rich in vitamin C, which reduces the basicity of urine».
And what about medications?
«If the urine culture, that is the urine test that identifies the bacteria responsible for the ongoing infection, reveals a low bacterial count it would be more appropriate to intervene by assuming probiotics, which among the beneficial effects contribute to making the surface of the genital mucous membranes more acidic, inhibiting the action of pathogenic bacteria. If, on the other hand, the bacterial load is high, the specialist establishes any specific antibiotic therapy on the basis of urine culture results and patient characteristics. Antibiotics are effective, but you need to talk to a doctor, preferably a urologist, so that he chooses the most suitable one in the individual case, with the dosages and duration of treatment. Going your own way you risk not getting the solution to the problem and in addition, in the long run, to become resistant to these drugs, no longer drawing any benefit from them, because the bacteria develop a capacity to survive the action of one or more drugs. So then it grows the risk of increasingly frequent cystitis and very often to get nagging vaginal candidiasis».
How to understand when the problem becomes chronic?
«There is a very different and much more disabling form of cystitis than that caused by bacterial infections: it is interstitial cystitis, a chronic and painful inflammation of the bladder wall, which affects women with a high prevalence (in a ratio of 5 to 1 compared to men). In practice, it’s like having a stubborn cystitis that does not want to know how to heal, with serious consequences on the quality of daily life, from work to social relationshipsup, of course, to compromise sexuality. Interstitial cystitis should be hypothesized when the prevalent symptomatology is pain in the suprapubic region and lower abdomen, associated with bladder filling, need to urinate frequently and urgently. This is followed by the imperativeness to urinate even immediately after urinating, despite having recently emptied the bladder. Interstitial cystitis typically is not associated with a urinary infection and the diagnosis is usually confirmed with cystoscopy. Also in this case there are therapeutic strategies: that pharmacological (which also includes glycosaminoglycan-based therapies used for restore and strengthen the mucous tissue of the bladder) is that endoscopicwith a procedure called bladder hydrodistentionwhich in addition to having a diagnostic purpose can act on the nerve endings responsible for pain”.
What are the causes and risk factors of bacterial cystitis?
«The first reason is of an anatomical nature: in women the urethra, i.e. the channel that leads to the bladder, is shorter than men and more easily passable by microbial agents – concludes Salonia -. The female anatomy in the genital area makes it moreover the urinary tract and the last part of the intestine very close together, certainly more than in men, making it easier for bacteria that can easily reach the bladder. The triggering factors, then, are varied. For example, penetrative sexual intercourse, as a result of which bacteria can more easily enter the urinary tract. Or constipation and irritable bowel syndrome, when the same bacteria multiply and can spread from the intestinal district to that of the urinary tract. Or again the menopause, because the lack of estrogen alters the pH of the vaginal mucosa, impoverishing it, and favors infections. In the end, improper personal hygiene: today there is a tendency to exaggerate with too aggressive soaps, which weaken the defenses and make vaginal infections more likely ».
April 1, 2023 (change April 1, 2023 | 07:01)
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